Last week my colleague, Dr David Laing Dawson, provided his own personal history of prescribing psychiatric medications since he became a physician in the late 1960s. David’s experiences fit in with the development of that profession as described by Dr Jeffrey Lieberman in his new book Shrinks, The Untold Story of Psychiatry. Lieberman is a psychiatrist himself, chair of the Department of Psychiatry at Columbia University and the past president of the American Psychiatric Association.

It is highly readable book and what I particularly enjoyed were his anecdotes based on his many connections within the profession. He points out that RD Laing, one of the father’s of the anti-psychiatry movement, had his “convictions ….. put to the test when his daughter developed schizophrenia. After that, he became disillusioned with his own ideas. People who knew Laing told me that he became a guy asking for money by giving lectures on ideas that he no longer believed in.”

Lieberman attributes this information to Dr. E Fuller Torrey. Lieberman also mentions that the other leader of anti-psychiatry, Thomas Szasz, made it clear that schizophrenia did qualify as a true brain disease but that he was never going to say that in public.

Of less intellectual interest is the origin of the term shrink. Headshrinker entered broad use after a 1950 Time Magazine article about Hopalong Cassidy saying that anyone who predicted that he would become a hero of kids would have been led off to a headshrinker – Hollywood jargon for a psychiatrist. Hopy was my hero and I still remember lining up for hours in Toronto wearing my Hopy chaps and vest waiting for a chance to shake his hand.

North American psychiatry was heavily influenced by the psychoanalysts who, Lieberman points out, followed a rigid set of theories that were not grounded in science or scientific proof. In fact, two psychoanalysts from different schools of thought would likely come up with different interpretations for the same patient. As a reaction to this lack of rigour, science and the criticism from anti-psychiatrist, some in the profession began to establish menus of symptoms for each disorder based on data from published research. This was an effort influenced by the Kraeplin approach of the previous century.

And while the psychoanalysts had always emphasized cause based on unconscious conflicts, the development of this new Diagnostic and Statistical Manual (DSM) was to be based on two key concepts. First was that the symptoms must be distressing to the individual or must impair his ability to function. Second was that these symptoms must be enduring. It is interesting that the development of the DSM partly arose from the criticisms of the lack of evidence by anti-psychiatrists. Today, the anti-psychiatrists argue that the DSM is pathologizing everyday life. Lieberman states that the DSM-5 has actually reduced the number of diagnoses to 265 from the 297 in the DSM-4.

In addition to his description of the serendipitous discoveries of effective anti-psychotics, lithium for mania and anti-depressants, Dr Lieberman’s comments about families will please all who have kids with schizophrenia. It is worth quoting in its entirety:

It was not enough that parents had to endure the tragedy of a child’s mental illness; after this onslaught of inane diagnostic formulations, they also had to suffer the indignity of being blamed for the illness because of their own misbehavior. Schizophrenia and bipolar disorder……were now believed to be curable through the right kind of talk therapy. Like a pet cat in a tree, a deranged individual merely had to be coaxed into climbing down to reality.